Individual provider Active NPI

Lauren Olivia Kelly, AUD

  • Audiologist
  • Chicago, IL
National Provider Identifier
1104476506
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
Practice address
1611 W Harrison St Ste 530
Chicago, IL 60612-4861
Phone
(312) 942-5332
NPI assigned
Sep 17, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X Primary

Addresses

Primary practice location

1611 W Harrison St Ste 530
Chicago, IL 60612-4861

Mailing address

2604 Dempster St Ste 501
Park Ridge, IL 60068-8429
Phone (847) 674-5585

Other practice location 1

8780 W Golf Rd Ste 200
Niles, IL 60714-5611
Phone (847) 824-4390

Other practice location 2

2604 Dempster St Ste 501
Park Ridge, IL 60068
Phone (847) 674-5585

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191217000853 IL Practitioner - Qualified Audiologist 4587098041 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rush University Medical GroupGroup PAC ID 5496658874, 1,521 clinicians

Practice addresses (Care Compare)

1611 W Harrison St
Suite 550
Chicago, IL 60612-4861
Phone (312) 942-6100

Hospital & facility affiliations

  • Rush University Medical Center Hospital, Chicago, IL, CCN 140119

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ear, Nose & Throat Specialists of Illinois LTD CurrentSince Nov 20, 2019 Accepting new patients
Rush University Medical Group CurrentSince Dec 2, 2024 Accepting new patients
Midwest ENT Alliance PLLC CurrentSince Nov 1, 2024 Accepting new patients
Bastian Voice Institute, LLC PastSince Sep 22, 2003 Accepting new patients

Locations

75 Remittance Dr
Dept 1611
Chicago, IL 60675

1611 W Harrison St
Ste 550
Chicago, IL 60612
Phone (312) 563-4431

1700 W Van Buren St
#500
Chicago, IL 60612
Phone (312) 563-2875

1611 W Harrison St
Ste 530
Chicago, IL 60612
Phone (312) 942-5332

3010 Highland Pkwy
Ste 550
Downers Grove, IL 60515
Phone (630) 724-1100

8780 W Golf Rd
Ste 200
Niles, IL 60714
Phone (847) 824-4390

2604 Dempster St
Ste 501
Park Ridge, IL 60068
Phone 8476745585111

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1104476506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2604 DEMPSTER ST STE 501",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600688429",
            "telephone_number": "847-674-5585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 W HARRISON ST STE 530",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124861",
            "telephone_number": "312-942-5332"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8780 W Golf Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Niles",
            "state": "IL",
            "postal_code": "607145611",
            "country_code": "US",
            "telephone_number": "847-824-4390",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2604 Dempster St Ste 501",
            "address_purpose": "LOCATION",
            "city": "Park Ridge",
            "state": "IL",
            "postal_code": "60068",
            "country_code": "US",
            "telephone_number": "847-674-5585",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "LAUREN",
        "middle_name": "OLIVIA",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-17",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.